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Emotional/Behavioral  Disorder  LIT  REVIEW  STRELA,  EVELINA  

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One child may be persistently acting out and obviously demanding attention, while

another may withdraw in fear and angst, away from all outside contacts. Both students may have

a disability under the same umbrella of an emotional/behavioral disorder, or EBD. As the name

implies, emotional/behavioral disturbance is a disability in which a student’s emotional state is

so unstable that it is outwardly visible by hindering their behavior.

The IDEA defines emotional/behavioral disturbance as “a condition in which a student

exhibits one or more of the following characteristics over a long period of time and to a marked

degree that adversely affects a student's educational performance: (a) An inability to learn that

cannot be explained by intellectual, sensory, or health factors; (b) An inability to build or

maintain satisfactory interpersonal relationships with peers and teachers; (c) Inappropriate types

of behavior or feelings under normal circumstances; (d) A general pervasive mood of

unhappiness or depression; and/or (e) A tendency to develop physical symptoms or fears

associated with personal or school problems” (WAC - http://www.k12.wa.us/SpecialEd/pubdocs/

WAC_392-172A.pdf). The following are some disorders and mental illnesses that the term

emotional/behavioral disorder includes: anxiety disorders (separation anxiety disorder, specific

phobia, panic disorder, social anxiety), mood disorders (ex. Bipolar disorder), oppositional

defiant disorder (ODD), conduct disorder (CD), and schizophrenia.

“According to the National Institute of Mental Health (NIMH), emotional and behavioral

disorders affect 10-15 percent of children globally” (Kidsmentalhealth.org, 2009). Among these

children, the disability can manifest itself in a variety of ways. One or both of the behavioral

patterns associated with it. Externalizing behaviors directed outward towards others, often in

search of attention and are persistently disruptive or annoying and include aggressive, acting out,

or noncompliant behaviors such as bullying. Internalizing behaviors are self-directed behaviors

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characterized by avoidance, compulsiveness, and withdrawal, and are often overlooked as EBD

in females (Turnbull, Turnbull, Wehmeyer, & Shogren, 2016). Both dimensions of behaviors can

be evident in all disorders under the EBD umbrella, but CD and ODD are often associated with

externalizing behaviors, and depression and anxiety with internalizing behaviors.

There is no single cause for emotional/behavior disturbance. A combination of multiple

biological and environmental risk factors are typically the causes. For example, Genetics

influence a child’s temperament (Davies, Cicchettie, Henteges, & Sturge-Apple, 2013) and when

an impulsive or resistant temperament interacts with challenging environmental factors, the

presence of EBD is at a higher risk (Turnbull, Turnbull, Wehmeyer, & Shogren, 2016). Also, “it

is now possible to discuss mood disorders in terms of specific brain systems, and there is no

question that there is a neurobiological basis for mood disorders” (Price & Drevets, 2011, p. 69),

because there is evidence that specific areas of the brain are involved in depression. From the

environmental contributions, school and family are the biggest factors. Teachers today often

have negative attitudes and are not prepared to teach these students with difficult behaviors and

do not use evidence-based practices for them, while students are underserviced and

misunderstood. Common family situations for children with EBD include single-parent

households, parent unemployment, poverty, and maternal depression (Goodman, Rouse, Connell,

Broth, Hall, & Heyward, 2011), which can all be causes of frustration, anger, and ultimately a

higher likelihood of EBD in a child growing up in these circumstances. So, because EBD isn’t

fully genetic or fully environmental, a combination of difference factors in the biology and life of

a student work together in the development of these disorders.

When a student has an emotional/behavior disorder, it has different implications on their

education. A student with EBD may be twice exceptional or their disability may have

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comorbidity with an intellectual disability or ADHD, but these students are often under-

identified, underserviced, and misunderstood when it comes to special education services

(Forness, Freeman, Paparella, Kauffman, & Walker, 2012) because as mentioned before,

teachers aren’t prepared for this disability so they may dismiss it as acting out or that the child is

simply a “trouble student.” Approximately 2/3 of students with EBD also have a language

disorder (Turnbull, Turnbull, Wehmeyer, & Shogren, 2016), meaning they lack necessary skills

for communicating and thus obtaining understanding from others, especially teachers, that they

need. Only about 38% of students with EBD graduate with a regular diploma, and the dropout

rate among these students is much higher than typically-developing peers (Turnbull, Turnbull,

Wehmeyer, & Shogren, 2016). While they may not have intellectual disabilities that hinder them

from learning concepts, the behavioral difficulties of students with EBD causes them to be

misunderstood and stereotyped, hindering their learning process.

While a child with EBD has no physical differences, as long as no other disabilities are

present, social differences are obvious. So, because an “IEP should address a student’s emotional

and social needs, not just the student’s academic needs,” (Turnbull, Turbbull, Wehmeyer &

Shogren, 2016 p. 106), let’s consider how a student with an emotional/behavioral disturbance

might be affected by it. Much of teacher to student interaction is focused around problem

behavior (Norton, 2016). Negative interactions can cause frustration or discouragement socially

for this student. Their interaction among peers is also often negative, with 80% of students with

EBD reporting they have carried out acts of bullying. Another social factor is in diagnoses, with

¾ of high school students identified with EBD being male, and 25% being African Americans,

showing disproportionality among gender and race/ethnicity. Students with EBD need not only

academic support, but also social and emotional support as well.

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To thrive and succeed in an environment where control and restraint of emotions and

behavior is expected, a student with an emotional/behavioral disorder must be provided with

opportunities that are modified to their own learning needs and processes. For one, a system of

intervention called wraparound is considered the most effective intensive intervention because it

provides services to meet all needs. The family, school, community, mental health, and other

services are ‘wrapped around’ the student instead of being separated by field, and come together

for collaborative planning (Turnbull, Turnbull, Wehmeyer, & Shogren, 2016). When the process

works, well, students can also be receptive to other intervention efforts such as social skills

interventions, self-monitoring, classroom-centered interventions, and behavior support plans. In

social skills interventions, skills such as cooperation, following rules, and getting along with

others are taught as academic enablers, or the attitudes and behaviors that allow students to

participate in and benefit from academic instruction in the classroom. Research shows that those

who have positive social interactions with peers are more academically engaged and have higher

levels of academic achievement (Gresham, 2015). An evidence-based intervention on self-

monitoring to improve graduation and reduce dropout rate is the Check and Connect program, in

which mentoring, monitoring student progress, and maintaining student and family connections,

is effective in keeping students in school. Classroom-centered intervention involves enhancing

curriculum, applying specific behavior management strategies, and providing additional supports

for students who are not performing adequately (Turnbull, Turnbull, Wehmeyer, & Shogren,

2016). Lastly, when functional behavioral assessments are used to determine the purpose of

behaviors, a behavior support plan can be put together, in which a team of people closely

involved with the student come together to develop a plan that will help change a student’s

problem behavior to something more desirable but will still achieve the student’s purpose

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(Norton, 2016). Of course, these are not the only options to teaching a child with EBD, and all

students will require different levels of intervention, but these evidence-based practices set a

good foundation for the inclusion of students with EBD in general education classrooms.

Only 43% of students with EBD are in regular class 80-100% of the time. And about

20% are educated in a separate setting, outside of school (Turnbull, Turnbull, Wehmeyer, &

Shogren, 2016). To include a student with EBD with typically developing peers, a teacher must

first make an effort to prepare and educate herself on this disability. Learning how to respond to

difficult emotions and behaviors will benefit both student and teacher the most. If teacher-student

interaction can be shifted from negative, problematic behaviors, to constructive and supportive

alternatives, students can learn to modify their behavior but get the same outcome from it. In

cognitive behavioral interventions (CBI), response to conflict behavior can be positive to teach

resolution skills instead of frustration and negativity (Norton, 2016). For a teacher to understand

the relationship between antecedent, behavior, and consequences, will be a turning point in

which student behavior is recognized, acknowledged, and monitored to change and prevent

future problems and allow for smoother inclusion in general education programs.

Emotional/Behavioral disturbance is a disability that conflicts with one’s mental health

and likely, indirectly hindering their intellectual ability as well. Although it is usually not evident

until a child is at least 1 or 2 years of age, it will likely affect them for their life, but with

knowledgeable teachers who use strategic behavioral interventions, these young students with

EBD can experience many opportunities to gain the skills needed to be successful in school

activities and outside social interactions.

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References:

Davies, P. T., Cicchetti, D., Hentges, R. F., & Sturge-Apple, M. L. (2013). The Genetic

Precursors and the Advantageous and Disadvantageous Sequelae of Inhibited

Temperament: An Evolutionary Perspective. Developmental Psychology, 49(12), 2285-

2300.

Forness, S. R., Freeman, S. N., Paparella, T., Kauffman, J. M., & Walker, H. M. (2012). Special

Education Implications of Point and Cumulative Prevalence for Children with Emotional

or Behavioral Disorders. Journal Of Emotional And Behavioral Disorders, 20(1), 4-18.

Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D.

(2011). Maternal Depression and Child Psychopathology: A Meta-Analytic Review.

Clinical Child And Family Psychology Review, 14(1), 1-27.

Gresham, F. (2015). Evidence-Based Social Skills Interventions for Students at Risk for EBD.

Remedial And Special Education, 36(2), 100-104.

Kidsmentalhealth.org. (2009). Childrens Behavioral and Emotional Disorders. http://www.

kidsmentalhealth.org/childrens-behavioral-and-emotional-disorders/

Norton, J. (2016). Emotional and Behavioral Disorders: Overview. PowerPoint Slides.

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Price, J. L., & Drevets, W. C. (2012). Neural circuits underlying the pathophysiology of mood

disorders. Trends In Cognitive Sciences, 16(1), 61-71. doi:10.1016/j.tics.2011.12.011

Turnbull, A., Turnbull, R., Wehmeyer, M. L., & Shogren K. A. (2016). Exceptional lives:

Special education in today’s schools. Boston: Pearson Education, Inc.

WAC - http://www.k12.wa.us/SpecialEd/pubdocs/WAC_392-172A.pdf